Skip to Main Content
Skip Nav Destination

AAP flu recommendations allow for coadministration with COVID-19 vaccine

September 7, 2021

The 2021-’22 AAP influenza policy statement and companion technical report released Sept. 7 emphasize the importance of flu vaccination during the SARS-CoV-2 pandemic, which is expected to continue during flu season.

Influenza vaccination is particularly important to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of SARS-CoV-2.

The policy Recommendations for Prevention and Control of Influenza in Children, 2021-2022, from the Committee on Infectious Diseases, is available at, and the technical report is at They also will be published in the October issue of Pediatrics.

Influenza vaccine is recommended for everyone 6 months and older with any licensed product appropriate for age and health status, according to the policy. Both inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are options. Similarly, any licensed, recommended, age-appropriate influenza antiviral medication can be used for treatment.

The AAP recommends antivirals for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of flu complications. Antivirals also can be considered for any previously healthy, symptomatic outpatient not at high risk for flu complications if treatment can be initiated within 48 hours of illness onset and for children whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to flu complications.

Influenza vaccine and COVID-19

Influenza vaccine can be administered simultaneously with or any time before or after administration of the currently available COVID-19 vaccines. Because it is unknown whether reactogenicity of COVID-19 vaccines will be increased with coadministration of flu vaccine, the reactogenicity profile of the vaccines should be considered. Clinicians should consult current guidance on coadministration of COVID-19 vaccines with influenza vaccines from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) ( and the AAP (

Children who have acute moderate or severe COVID-19 should not receive influenza vaccine until they have recovered. Those with mild illness can be vaccinated.

“As we continue to face another year of the COVID-19 pandemic, timely influenza vaccination of all persons 6 months of age and older is a priority this year,” said Flor M. Munoz, M.D., M.Sc., FAAP, a lead author of the policy statement. “This is particularly important for anyone who has medical conditions that increase the risk for complications for both influenza and COVID-19, including children.”

Additional updates for 2021-’22

Composition: For the first time, all pediatric and adult influenza vaccines are quadrivalent. Viral strain components influenza A(H1N1) pdm09 and A(H3N2) components are new, while influenza B components are unchanged from last season.

Vaccine formulations for children 6 through 35 months of age also are the same as last season. Afluria Quadrivalent is the only vaccine for children in this age group available in a dosing volume of 0.25 mL prefilled syringe. Fluzone Quadrivalent, which previously was available in a 0.25-mL and a 0.5-mL prefilled syringe, is available only in a 0.5-mL dose for this group. However, a 0.25-mL dose still is an approved option if drawn from a multidose vial. The presentation and approved dose for the two other vaccines available for this age group, Fluarix and FluLaval, is 0.5mL.

The age indication for the cell culture-based inactivated influenza vaccine, Flucelvax Quadrivalent, has been extended to ages 2 years and older (previously 4 years and older).

Doses, timing: All influenza immunization doses should be completed by the end of October, if possible. Children ages 6 months through 8 years who are receiving flu vaccine for the first time, who have had only one dose ever prior to July 1, 2021, or whose vaccination status is unknown should be vaccinated as soon as vaccines become available so they can receive two doses four weeks apart by the end of October. Data available to date on waning immunity do not support delaying vaccination in children.

The language in the policy statement on contraindications for IIV and LAIV has been updated to harmonize with ACIP recommendations and package inserts. A documented previous severe reaction to any IIV or LAIV is a contraindication to vaccination.

Other recommendations

  • Children 6 through 35 months of age can receive any licensed, age-appropriate IIV available this season, at the dose indicated for the vaccine. Children 36 months (3 years) and older should receive a 0.5-mL dose of any available, licensed, age-appropriate vaccine.
  • Efforts should be made to ensure vaccination of children in high-risk groups and their contacts, unless contraindicated.
  • Product-specific contraindications must be considered when selecting the type of vaccine to administer. Children who have had an allergic reaction after a previous dose of any influenza vaccine should be evaluated by an allergist to determine whether receipt of the vaccine is appropriate.
  • Children with egg allergy can receive IIV or LAIV without any additional precautions beyond those recommended for all vaccines.
  • Pregnant women should receive IIV at any time during pregnancy to protect themselves and their infants. Women in the postpartum period who did not receive vaccination during pregnancy should receive influenza vaccine before hospital discharge. Influenza vaccination during breastfeeding is safe for mothers and their infants.
  • The AAP supports mandatory influenza vaccination of health care personnel.


Close Modal

or Create an Account

Close Modal
Close Modal